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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Major depressive disorders complicate recovery from acute coronary syndrome in approximately 1 in 5 patients, and have been found to be associated with significant impairments of quality of life and functioning. The aim of the present analysis was to evaluate the efficacy of sertraline in improving quality of life and functioning in patients diagnosed with major depression who had recently been hospitalized for acute coronary syndrome. Three hundred sixty-nine patients hospitalized in the previous month for acute coronary syndrome (myocardial infarction, 74%; unstable angina, 26%) who also met criteria for major depressive disorder were randomized to 24 weeks of double-blind treatment with sertraline (50 to 200 mg/day) or placebo. Quality-of-life and functional status were assessed using the Quality of Life, Enjoyment, and Satisfaction scale (Q-LES-Q) and the Medical Outcomes Study SF-36. Data from the total sample, and the recurrent depression subgroup, were analyzed. Severe baseline impairment was found in the Q-LES-Q and all subscales of the SF-36. A multivariate regression analysis identified depression as the strongest predictor of baseline quality-of-life impairment (partial r, -0.37, p = 0.001). In the recurrent depression group, treatment with sertraline resulted in significantly greater improvement than placebo in the Q-LES-Q total score and SF-36 mental component summary score, as well as the SF-36 role limitations, emotional, and mental health factors. Depression has a substantial negative impact on quality of life and functioning in patients hospitalized for acute coronary syndrome. Sertraline was associated with clinically meaningful improvement in multiple quality-of-life domains in patients with acute coronary syndrome and recurrent depression.
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PMID:Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome. 1508 67

BACKGROUND: New medications that enter the marketplace have been tested almost exclusively in controlled clinical trials conducted in specialty research settings. There is some concern that these carefully selected patient samples may not provide information generalizable to the "real world" clinical population. The purpose of this investigation was to compare results from a large, open-label study of sertraline in the treatment of major depression in the clinical practice setting with pooled results from 2 multicenter, double-blind, placebo-controlled studies conducted in specialty research settings. METHOD: Clinical practice patients (N = 1482), aged 21 to 65 years, from 228 psychiatric clinical practice sites across the United States participated in the open-label treatment study (Clinical Practice sample). Patients who met DSM-III-R criteria for moderate-to-severe unipolar major depression (i.e., had pretreatment Hamilton Rating Scale for Depression [HAM-D] scores >/= 18) were treated for 8 weeks with sertraline in a flexible dosing fashion (50-200 mg daily). Outcomes on the HAM-D and Clinical Global Impressions-Improvement scale (CGI-I) were compared with the pooled results from 2 previously published placebo-controlled, multicenter treatment studies of sertraline in outpatients with major depression (N = 280). The overall response to sertraline in the Clinical Practice sample was compared with the outcome from the research study patient sample (Clinical Research sample). Additionally, comparison of outcomes of patients with common depressive subtypes (double depression, anxious depression, and melancholic ["endogenous"] depression) were examined. RESULTS: The percentage of sertraline-treated patients rated as responders on the CGI-I was significantly higher in the Clinical Practice sample compared with the Clinical Research sample (87% vs. 73%; p <.001). Sertraline was also much better tolerated in the Clinical Practice sample than in the Clinical Research sample as evidenced by significantly lower overall reports of adverse events (9.4% vs. 13.2%; p <.05) and lower patient dropout rates (17.5% vs. 34.3%; p <.01). Among clinical practice patients, sertraline was found to be equally effective in treating endogenous/melancholic and anxious subtypes and only mildly less effective in achieving a response in patients with double depression (chronic low-grade depression with a superimposed major depression). A regression analysis identified older age and double depression as being predictors of a slower time to response. More than 70% of patients who reported nonresponse to previous treatment with fluoxetine or a tricyclic antidepressant responded to sertraline. CONCLUSION: The effectiveness and tolerability of sertraline treatment was found to be significantly better in the Clinical Practice sample, suggesting that the results from controlled studies in research settings may represent an underestimate of the benefits of a drug. More effectiveness research is needed to confirm and extend these findings.
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PMID:From the Bench to the Trench: A Comparison of Sertraline Treatment of Major Depression in Clinical and Research Patient Samples. 1501 77

Major depressive disorder (MDD) in the elderly, children, and patients with unstable angina or acute myocardial infarction (MI) is a serious disorder. In elderly patients, where major depression is often overlooked and may have a significant impact on the quality of life, the goal of therapy is full remission. Selective serotonin reuptake inhibitors (SSRIs) have the most favorable combination of efficacy and side-effect profile for the elderly with MDD, regardless of the presence of medical comorbidities. Although the dual agent venlafaxine has been proposed as an alternative agent for older patients who are either nonresponders or partial responders to SSRIs, the frail elderly may be particularly vulnerable to its side effects. Most elderly patients have a relapse of depression when antidepressants are stopped; depression subsides when antidepressants are resumed. Because recent evidence suggests that the dosage of an antidepressant that achieves remission in the elderly does not always protect against recurrence, in addition to long-term maintenance, consideration should be given to increased dosage. Patients with major depression and either unstable angina or acute MI should be identified and considered for antidepressant treatment. Findings from the recent Sertraline Anti-Depressant Heart Attack Randomized Trial suggest that SSRIs may have antiplatelet and endothelium-protective properties that may benefit patients with depression and comorbid coronary artery disease and ischemic stroke. Concern regarding the safety of SSRIs in children has prompted new studies. Evidence suggests that the risks of SSRIs, except for fluoxetine, might outweigh benefits in the treatment of depression in children and adolescents.
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PMID:Recent developments in antidepressant therapy in special populations. 1535 75

(1) An antidepressant that worked in a depressive episode can be used to prevent recurrences in patients who do not have bipolar disorder. Several antidepressants are at least partially effective in this setting. (2) Sertraline and venlafaxine are now authorised in France for the prevention of recurrent depression. (3) Sertraline and short-acting venlafaxine were both more effective than placebo in single trials (although the data on venlafaxine were somewhat weaker than the data on sertraline). Neither trial has been published in detail. There are no trials comparing sertraline or venlafaxine with other antidepressants in this setting. (4) These trials confirmed the known adverse effect profiles of sertraline and venlafaxine. (5) In practice, these licence extensions have no clinical implications for the management of depression.
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PMID:Sertraline and venlafaxine: new indication. Prevention of recurrent depression: no advance. 1575 Nov 71

Depression is highly prevalent in patients with cardiovascular disease and is independently associated with a poor prognosis when present. A very important aspect of continued therapeutic advances in this field will be the ability to show a convincing connection between the treatment of depression in patients with heart disease and a reduction in morbidity and mortality associated with the co-occurrence of these conditions. The recent SADHART (Sertraline AntiDepressant Heart Attack Trial) investigation demonstrated that sertraline is safe and efficacious in depressed patients with ischemic heart disease but was underpowered to detect a mortality difference between sertraline and placebo. The ENRICHD (ENhancing Recovery in Coronary Heart Disease) trial showed that cognitive-behavioral therapy is effective for treating depression but had no impact on cardiovascular morbidity or mortality. There are a number of methodologic complexities associated with research regarding depression and cardiovascular disease, including difficulties in the definition and measurement of depression, complexities in the conduction of large-scale trials, ethical considerations surrounding the use of placebo, and interpretation of trial results. In addition, the lack of certainty regarding the pathophysiologic link between depression and cardiovascular disease means that there is a lack of pharmacotherapy targeted specifically at the dysregulated physiology that might explain the increased morbidity and mortality seen when these two conditions occur together.
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PMID:Lessons from SADHART, ENRICHD, and other trials. 1595 5

Affective and schizophrenic illnesses are associated with an elevated--in particular cardiovascular-related--risk of mortality. Patients with a cardiac disease who suffer from episodes of depression should be treated with selective serotonin reuptake inhibitors. Sertraline and citalopram have a low potential for interaction. Thioridazine, pimozid and ziprasidone are the substances that most commonly lead to lengthening of the QTc interval and thus to repolarization disorders. However, the results of studies carried out to date show that, in contrast to thioridazine and pimozid, ziprasidone has not so far been suspected of having an association with sudden heart death. Prior to starting treatment with tricyclic antidepressants or neuroleptics, a baseline ECG should be obtained. Follow-up ECG should be recorded and consideration given to possible drug interactions leading to cardiac arrhythmias, in particular when low-potency antipsychotics are used.
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PMID:[Relationships between mental and cardiac diseases]. 1628 82

We observed the relief of hot flashes in breast cancer survivors taking tamoxifen and treated with sertraline for depression. Our objective was to assess the effect of sertraline on the frequency and severity of hot flashes, mood status, and health-related quality of life. We used a randomized, double-blind, placebo-controlled, crossover study using 6 weeks of sertraline (50 mg each morning) versus placebo. Study participants were 62 breast cancer survivors from an oncology clinic in a tertiary care center on adjuvant tamoxifen reporting bothersome hot flashes. Patients were asked to keep a daily hot flash diary to record hot flash frequency and severity, from which hot flash scores (frequency x severity) were calculated. The Center for Epidemiologic Studies depression scale and Functional Assessment of Cancer Therapy--Breast (FACT-B) (at baseline, 6 weeks, and 12 weeks) were used to assess mood and quality of life. Sixty-two women were accrued. Forty-seven women (median age 53.9 years, range 36.6-77.1 years; 89% postmenopausal; 85.5% Caucasian) completed the first 6 weeks and 39 completed 12 weeks. The baseline daily hot flash frequency and score were 5.8 (standard deviation 4.1) and 11.5 (14.0), respectively. At the end of the first 6 weeks, hot flash frequency decreased by 50% in 36% of those taking sertraline compared to 27% taking placebo. In the crossover analysis, sertraline was significantly more effective than placebo: women crossing from placebo to sertraline had a decrease (-0.9 and -1.7) in hot flash frequency and score, whereas those crossing from sertraline to placebo had an increase (1.5 and 3.4) in hot flash frequency and score (p = 0.03 and 0.03). Forty-eight percent preferred the sertraline period, 11% preferred the placebo period, and 41% had no preference (p = 0.006). Measures of depression and quality of life were within normal range and did not change significantly within treatment groups. Sertraline decreases hot flashes in breast cancer survivors taking tamoxifen and women prefer sertraline to placebo. Further study of sertraline for the management of hot flashes is warranted.
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PMID:Randomized, double-blind, placebo-controlled, crossover study of sertraline (Zoloft) for the treatment of hot flashes in women with early stage breast cancer taking tamoxifen. 1650 35

We assessed the effect of 3-month treatment of sertraline (50 mg) or low-dose amitriptyline (25 mg) on depression and quality of life in 31 patients with Parkinson's disease in a prospective single-blind randomized study. Both drugs significantly reduced the Hamilton Depression Rating Scale (HDRS-17) score. Completion rate was 75% for sertraline (12 of 16) and 73% for amitriptyline (11 of 15). Responder rate (HDRS-17 score reduction >/= 50%) was 83.3% for sertraline and 72.7% for amitriptyline. Sertraline but not amitriptyline treatment determined a significant benefit on quality of life (PDQ-39 scale). We found no change in Unified Parkinson's Disease Rating Scale scores. However, the improvement in specific PDQ-39 subscores (mobility, activities of daily living, and stigma) suggests that depression affects patient self-perception of motor function and further emphasizes the need for its treatment.
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PMID:Randomized study of sertraline and low-dose amitriptyline in patients with Parkinson's disease and depression: effect on quality of life. 1663 39

Zoloft (sertraline hydrochloride) is one of the antidepressant medications used to treat depression, obsessive-compulsive disorder, and social anxiety disorder. The practice of embalming a cadaver is common, yet it may create problems for forensic toxicologists if the case was not previously suspected to involve drug overdose. According to the Eschweiler-Clarke reaction, drugs containing a secondary amine group react with formaldehyde to give N-methyl derivatives. Sertraline has a secondary amine group; therefore, we predicted that it may react with formalin to give N-methyl derivatives. The stability of sertraline in formalin solution was studied at three different concentrations (5%, 10%, and 20%) and at three different pHs (3.0, 7.0, and 9.5) for a period of 30 days. Setraline and its degraded products were extracted by liquid-liquid extraction using chloroform, and the concentrated extracts were analyzed by gas chromatography-mass spectrometry using electron impact ionization mode. The rate of conversion is rapid at higher pH. Sertraline was totally converted to the N-methyl derivative after 30 days in 10% and 20% formalin solutions at neutral and basic conditions. Therefore, forensic toxicologists should be cautious when performing a death investigation if formalin solution is the only sample available for analysis. This work shows that analysis for parent drug or its N-methyl derivative may provide data that will reduce the likelihood of false negatives.
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PMID:Conversion of sertraline to N-methyl sertraline in embalming fluid: a forensic implication. 1687 72

Some authors treated a two groups of patients with postpsychotic depression in a groups of patients with schizophrenia. Sertraline proved better than imipramine in view of earlier onset of action and lower incidence, intensity and duration of adverse effects and lower risk of schizophrenie symtom recurrence (Ref 4).
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PMID:Treatment of postpsychotic depression with sertraline in patients with schizophrenia. 1712 63


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